Italy Expat Healthcare Guide
Italy is the stuff of myth and legend. A stunningly scenic country, offering everything from sleepy rural villages that seem to be trapped in time, through to busy and bustling modern cities offering some of the best shopping and dining experiences in the world.
From the Leaning Tower of Pisa, through to Pompeii, Vatican City, the Acropolis and more, Italy is a country just begging to be explored. Round every corner the interested visitor will find new experiences and sites that will stay with them for life.
Little wonder, then, that every year almost 50 million of us arrive to explore this most historic and culturally-significant part of Europe.
Italy’s climate is surprisingly diverse thanks to a number of factors working in conjunction. Firstly, and of greatest impact, Italy’s elongated shape means that it’s more southerly tip experiences a balmy Mediterranean climate while more northerly areas are typically much milder.
Secondly, Italy sits on the border between two tectonic plates, which has helped to create an impressively mountainous country. The Apennine mountain range bisects the country rather like a spine while Italy’s northern border with mainland Europe is largely delineated by the Alps.
Unsurprisingly, with increased altitudes come cooler weather. Winters can be bitter, with snow and freezing temperatures in more mountainous regions, while the south of the country bathes in far more comfortable temperatures. The average winter temperature in the north sits at 0’C while the south experiences an average of 12’C during the colder months.
This same tectonic action has also helped to create a number of volcanoes, some of which are almost household names. Mount Etna and Vesuvius are two of the best known; the latter being the only volcano to be found anywhere in mainland Europe.
As a final factor impacting Italy’s climate, this relatively narrow peninsula, with its extensive coastline, means that areas close to the ocean often enjoy a pleasant breeze, taking the edge off excessive summer heat in the south (or bringing even colder weather in the north).
So while many books and websites like to define Italy’s climate as “Mediterranean” the truth, as you can see, is far more nuanced. Depending on your location you might experience considerable deviations from this comfortable yet mildly inaccurate generalisation.
Italy is a veritable gold-mine of culture that has influenced the world for millennia. Home of the Roman Empire, whose effects can still be felt around Europe, Italy was also central to the Renaissance period.
Just a few of the famous names to have hailed from Italy over the years include artists Raphael and Michelangelo, polymath Leonardo Da Vinci and scientist Galileo Galilei. Even Alessandro Volta, the inventor of the battery, carried out his pioneering research in Como, Italy.
This vast cultural impact can still be enjoyed today in the numerous museums, historical buildings and art installations to be found here. Indeed, Italy boasts more UNESCO World Heritage Sites than any other country in the world.
Modern Italian culture is defined by a number of national traits. First is the importance of appearance. Even when asked to dress “casually” for a meeting or dinner reservation gentlemen are advised to wear a jacket and tie. Indeed, many of Italy’s best-known exports now revolve around this appreciation for style and luxury.
Many global style magazines, such as Vogue and Vanity Fair, call Italy home. So too do a number of the most iconic brands in the world, including Ferrari, Bulgari, Armani, Gucci and Prada. In Italy, appearances really do matter.
However don’t let this prevalence of major design brands lead you to think that Italy is all style and no substance. Indeed, nothing could be further from the truth. Over 80% of the current population define themselves as Roman Catholic, while the family unit is still key to life in Italy. Particularly in southern areas it is entirely normal for extended families to live together under one roof; something that is almost unheard of in many other countries.
Italy’s strong cultural identity has led to it being a major draw for generations. As a result, immigrants are a simply a way of life. Today, over 8% of the population was born overseas and Italy also boasts a strong tourist industry.
This has two distinct benefits for expats. The first is that you can expect to be welcomed with open arms, rather than feeling like you’re “in the way” as can happen with some other countries. Secondly, especially around the areas popular with tourists, you will find a reasonable number of fluent English speakers which can be the perfect elixir for anyone embarrassed by their stuttering schoolboy-level Italian.
In essence, Italy’s people can be as warm and welcoming as their summer weather, even if being greeted by the classic two-cheek kiss does take some getting used to for more reserved visitors.
Unsurprisingly the prevalent language in Italy is Italian. Italy’s long history of drawing immigrants from other countries does however mean than an astonishing number of other languages may be encountered or understood by some of the population. Alongside widespread languages like French and German one will find even Albanian to be far from uncommon.
English is a mandatory subject taught in all Italian schools, though generally its uptake as a second language is below that experienced by many other Western European countries. While English is most commonly spoken around the more touristy areas, and by the younger generation, the reality is that even some basic Italian language understanding can go a long way.
Speak to anyone that has visited Italy and there’s one form of transport that keeps on cropping up time and again. No, we’re not talking about whizzing around Rome on a Vespa; instead we’re talking about the practical and affordable rail network.
Not only do trains service an extensive network of towns and cities, but travelling by train can be a truly pleasurable experience. In comparison to many other countries Italy’s trains are clean, efficient and are comparatively timely.
For those visitors who plan to travel extensively by train there are even Rail Passes which can be bought, covering unlimited travel for a set period of time. Just as good, your Rail Pass also comes complete with a neat booklet providing easy-to-digest train times for a wide range of destinations.
Despite the many benefits of train travel in Italy, there are a few things that you should note. Firstly, most train tickets do not actually specify the date of travel. To prevent rail users from re-using the same ticket over and over, it is necessary to “validate” tickets before alighting. Simply pop your card into the yellow machines by every platform to do so.
Secondly, it is important to understand that there are typically two classes of seats on most Italian trains; namely first class and second class. Unlike many other countries, where first class seats are infinitely more expensive than second class, in Italy the average first class seat costs only 20% or so more. As these first class cabins provide far more leg room, and are typically much less crowded, many visitors happily stump up the small additional charge to benefit from such luxury.
Thirdly and finally an odd quirk of the Italian rail network is that you will need both a train ticket and a reservation to travel on many trains. Many travellers complain that it feels like you’re paying for your ticket twice over, but in reality train travel in Italy is so reasonably priced that it is difficult to complain. Many expats actually grow to love the reservation system, whereby you can be guaranteed a seat rather than having to run the gauntlet of standing for hours on end on a train.
The truth is that once you’ve successfully navigated your first train journey, you’ll wonder what all the fuss was about. What’s more, you’ll likely enjoy travelling by train as it is one of the quickest and easiest ways to get around this beautiful country.
Of course, trains don’t service every town and village so it may be necessary on your trip to investigate additional or alternative sources of transport. Fortunately, there are a number of suitable options to consider.
The first of these are the many buses which service even the tiniest of destinations. Even cheaper than the rail network, buses are less popular with tourists for two reasons. Firstly, the comfort levels are considerably below what one might reasonably expect when travelling by train.
Secondly, and even more importantly, there is no nationwide bus service. What this means in practice is that travelling across geographic boundaries can be problematic. If one intends to begin a bus journey in one province, and arrive at a destination in another, there is little chance of being able to use a single bus ticket. Instead it may be necessary to purchase multiple tickets with a range of bus companies, carefully navigating your way between them at the appropriate points.
Consequently, while buses can be a practical and cost-effective means of transport over short distances, over longer distances it can be far less practical.
Within more urban areas there are almost as many taxis as tourists, so catching a cab across town is simplicity itself. Unlike some other countries, taxis are generally not hailed on the street. Instead you can catch a ride from one of the many taxi ranks where they congregate, or request a collection by “radio taxi”.
It is crucial to appreciate that in Italy radio taxis start the meter running from the moment they receive your call, rather than from when they arrive at your collection point. As a result, you could step into a taxi to find a not inconsiderable tariff already on the meter. Additionally, note that very few taxis in Italy accept credit or debit cards, so you should be sure to have enough cash to hand to settle the bill.
Hiring a car in Italy is relatively simple, though driving in major cities can require nerves of steel. Traffic, especially at rush hour, can be atrocious, resulting in drivers sitting stationery for long periods of time. In comparison to the train, for example, driving can be a frustratingly slow way to get around the city.
Visitors should also be aware that parking places can be hard to come by, that many cities possess a complex network of one-way systems and that private vehicles may not enter historic city centres without possession of an official pass. If hiring a car, enquire about whether they can provide such a pass to you.
The sad reality, therefore, is that driving within cities is normally best avoided due to the frustrations and impracticalities this can entail. In more rural areas, however, hiring a car can prove an enjoyable and practical solution for reaching the tiniest of destinations. Roads in the countryside tend to be in reasonable condition and traffic is light.
Should you decide to drive while in Italy, be aware that Italian drive on the right-hand side of the road, and that it is a legal requirement to carry your passport and driving license with you at all times. British guests may use their standard driving license in Italy, while most other nationalities will need an International Driving Permit.
Italy has an impressive track record when it comes to healthcare. In general hospitals and doctors surgeries are highly regarded, life expectancies are good and treatment costs are reasonable. No wonder that in the year 2000 Italy was claimed to have the 2nd best healthcare system in the world.
That said, there are some critical factors that newcomers to Italy should be aware of. Firstly, there is a vast difference between coming to visit as a tourist and living here long term. Secondly, visitors from the EU are subject to different rules and regulations than those from outside. If you are to receive the best possible healthcare in Italy it’s crucial that you understand these differences, so as to ensure timely and cost-effective treatment is available if required.
For tourists arriving from within the European Union, a free EHIC card gains access to reciprocal routine healthcare services. That said, as always when discussing EHIC cards, be aware that there are a broad range of treatments not covered under the agreement. Consequently, some European visitors still opt for additional travel health insurance to facilitate a full range of care facilities at reasonable prices.
Tourists from outside the EU are not covered by any reciprocal healthcare agreement, and so will need to investigate options for private medical insurance before arrival in the country.
In terms of expats living in the country for longer periods of time it is possible to register for the Italian-equivalent of the UK’s National Health Service. Known in Italy as the Servizio Sanitario Nazioanale (SSN), registration facilitates EHIC-like care in hospitals and surgeries. Note, however, that even SSN registration does not guarantee completely free treatment; it is commonplace for some sort of co-payment to be required when visiting the hospital or requesting prescription medications.
On receipt of your residency card, you should apply for a Health Insurance card from your local health authority office. This card must be presented whenever medical care is sought, and is renewed annually. Your employer should take care of the routine payments required to remain it in good standing.
While registration for SSN is a legal obligation after 90 days of residency in Italy, many expats still opt to add further healthcare coverage through an expat insurance firm.
There are a number of reasons for this. Firstly, while there are many hospitals of international standard in Italy, the reality is that others provide facilities which many people would consider below their expectations. This are particularly so in the south of the country.
Private healthcare insurance opens the door to private hospitals to be found in Italy, many of which offer exceptionally high standards of care, English-speaking doctors and comfortable rooms.
The second reason many expats consider investing in private insurance is that the waiting lists for procedures in state-funded facilities can often be consideration. Having access to private clinics often cuts down this queue considerably.
Note that while it is possible to visit private facilities without insurance, the costs of such an exercise can often be prohibitive. The Italian government sets minimum fees payable for procedures which drives up the cost of such care. As a result, for most expats and travellers fully-featured expat or travel health insurance is likely to be the only financially viable solution.
The currency of Italy is the Euro. Unlike some other countries, alternative currencies such as US dollars or Sterling are rarely if ever accepted.
In order to access Euros either consider bringing cash with you or withdrawing Euros from one of the many ATMs to be found around Italy. Alternatively consider investing in one of the prepaid Euro debit cards which will allow you to withdraw Euros at a good rate from cash points.
Most Italian businesses accept credit cards though in general Italy should be considered a primarily cash-carrying society. For this reason you should expect to keep reasonable sums on you at all times for situations (such as taxis) that do not accept cards. Oddly, this can actually be a good thing. The reason for this is that many Italian business-owners loathe having to pay the exorbitant fees required to accept a card transaction. Asking whether there is a discount for paying in cash can often yield impressive discounts.
In terms of exchanging currency, visitors are advised to only use established banks. There are two reasons for this. Firstly banks tend to offer far better exchange rates than stand-alone bureaux de change, and secondly there are a surprising number of fake bank notes in circulation. Be aware that a common scam is for a passer-by in the street to enlist your assistance in breaking a large note. No matter how real the note may appear, many tourists have discovered to their detriment that they have been handed a worthless piece of paper in exchange for all their change.
Traveller’s checks are rarely accepted in Italy, and the currency exchange rates offered on them largely rule them out as a viable source of revenue for visitors.
Education in Italy is mandatory between the ages of 6 and 16, and the Italian education system is generally highly regarded. That said, expat parents should be aware that schools in the north of the country generally seem to offer higher levels of academic achievement than those in the south if exam grades are to be believed.
When it comes to education in Italy there is both good news and bad for expats. Let’s start off with the good news; public schools in Italy are free to attend, even for foreigners living in the country. Indeed, even the public universities, while not free, are heavily subsidized. This can make Italy a fantastic country for cost-effective schooling.
Additionally, schools in Italy are legally obliged to accept any school-age children interested in attending. This largely eliminates the “catchment area” problems experienced by much of Europe, where many parents end up having to send their children to less-desirable schools on account of their residential location.
Now the bad news; as almost all lessons are taught in Italian the reality is that most expats opt to send their children to one of the many English-speaking private international schools. Here parents can feel certain that their child won’t suffer with an unfortunate language barrier. Additionally, class sizes are typically smaller in private schools, meaning that pupils receive a higher level of one-to-one care than they might at a state school.
The downside to these private schools is the same which plagues private educational establishments the world over; principally that they are painfully expensive to send your children to. As a result expat parents would be well advised to try and negotiate an expat package which incorporates coverage for private schooling.
Food & Drink
Like their art and culture, Italian cuisine has a truly global appeal. That said, numerous visitors have been keen to point out that the Italian food you may enjoy in the UK or USA is considerably different to what one might experience in Italy.
A perfect example of this is pizza. As it turns out there is considerably more variation in true Italian pizza than you might find at your local grocery store or Italian restaurant. Not only do not all Italian pizzas have the classic tomato sauce, but there is almost endless variety in the thickness and style of pizza base which may be experienced here. There are also significant geographic variations in pizza recipes, so even travelling around the country one cannot be certain the experience the same dish.
As a final note on the subject of pizzas, note the key difference between a pepperoni pizza and a peperoni pizza – the extra letter “p” makes all the difference. While pepperoni (two p’s) is a thinly-sliced sausage, peperoni (one p) is Italian for pepper. As a result a number of visitors to Italy have ordered a peperoni pizza only to be perplexed by the lack of Pepperoni to be found on their dinner.
Pasta may also surprise the first-time visitor. Not only are there over 350 recognized types of pasta in Italy, but the portion sizes are often considerably smaller than you may be used to. This is because in Italy it is entirely normal for pasta to form just one of many courses, rather than being the “main event” as in many pseudo-Italian recipes around the world.
Classic Italian cookery is perhaps most notable for its simplicity. In contrast to many other countries, where chefs combine a dizzying array of ingredients to tickle the taste buds, many delicious Italian dishes consist of half a dozen ingredients or less. Instead, Italian chefs rely on only the highest quality ingredients available. They aim to create dishes which truly show off the earthy flavours such ingredients boast, rather than masking them with numerous herbs, spices and other additives.
Another notable cultural trait in terms of cuisine is that breakfast is typically a very lightweight meal. One will rarely find eggs and bacon on offer except in tourist hotels. Instead, a typical Italian breakfast will consist of bread and jam or pastries, accompanied by top quality coffee. Of the many, many coffee varieties available, Cappuccino is considered the classic breakfast coffee. Only heathens (and foreigners) would drink such a beverage later on in the day, when other coffees take prevalence.
It is interesting to note that life expectancy in Italy is among the highest in the world. Doctors largely attribute this to the so-called “Mediterranean diet” enjoyed here, frequently consisting of seafood, pasta, fruits and vegetables. To this generous slugs of virgin olive oil and/or wine may be added.
Speaking of wine, Italy is truly a wine-lovers paradise. Not only does Italy boast a dizzying range of top-quality vintages, but wine is tremendously reasonably-priced. In contrast to restaurants in most other countries, in Italy it is customary to dispense with the eye-watering supplements typically paid for wine bought with a meal. Indeed, with many fine tipples available for a matter of a few Euros per bottle it seems almost criminal not to take advantage of the opportunity.
Lastly, be aware that many Italian restaurants charge extra for bread, in contrast to many countries where it is served for free at the beginning of a meal. Unless you’re certain that you want bread, it might be wise to ask your waiter to remove it, lest you dig in assuming the bread to be free, only to be met by an unexpected surcharge on paying the bill.
Italy is generally a very safe country, with few major risks. Arguably the greatest of these relatively minor annoyances is the growing trend for petty crime in the form of bag snatches and pick-pocketing. As one might expect, these situations occur most commonly in and around the major cities (Rome, Milan and Pisa for example) and on public transport.
In order to minimize the risk of becoming a target there are a few common-sense precautions that may be taken. Firstly, aim to keep valuables hidden as much as possible, especially when travelling by bus or train, and keep your luggage to hand at all times.
Some experts also recommend employing the use of a money belt to make it difficult for pickpockets to prosper, or alternatively carrying only the cash you will need for that day, while locking credit cards and additional cash away at home for safety.
It is worth noting that in the case of any incident, Italy boasts a multi-lingual call centre. Simply dial 800 000 039 from any landline or mobile while within the country in order to be connected to this useful expat service.
A second risk in Italy comes from the traffic. Italians are infamous for their aggressive driving tendencies which, when combined with heavy rush-hour traffic, can lead to problems. In addition, the popularity of mopeds in Italy can create difficulties as these tiny vehicles appear out of nowhere, swerving in and out of traffic, often at break-neck speeds.
Whether you plan to drive in Italy yourself or not, it’s likely you’re going to need to cross a road from time to time. In such situations visitors should be very careful about looking both ways before stepping off the pavement, and not putting their trust in another driver dutifully breaking as you cross.
Places to Visit
With more than 50 UNESCO World Heritage sites, some of the best shopping districts in the world and enough museums and art galleries to keep even the most avid culture fanatic entertained for years, Italy represents a rich patchwork of exciting destinations. Here are some of our favourites…
For more information on moving abroad visit www.gov.uk/knowbeforeyougo.
Of course, if you’re planning on travelling abroad please ensure you have adequate expat travel insurance.
This iconic building, recognized around the world, was the largest amphitheatre ever built. Designed to seat over 80,000 spectators for gladiatorial fights and dramatic adaptations, it is rightly one of Italy’s most popular tourist destinations.
Visit to soak up the incredible atmosphere of this most monumental of buildings, and to learn about the history of the Colosseum in the two millennia since its creation. Recently opened, visitors can even go underground now, exploring the caverns and passageways beneath the building, designed to ferry gladiators to their sparring matches.
Well-known as the birth place of St Francis, this rustic village has a timeless charm all of its own. Climb up high to the Basilica of San Francesco where St Francis is buried, and explore its stunning architecture, not to mention the breath-taking views of the valley below.
For keen walkers, consider the trek to the old hermit caves known as Eremo delle Carceri and imagine what life must have been like living in this most serene of environments.
Recognized as the world’s smallest independent state, this walled city exists like a “country within a country”. Vatican City maintains its own government and police force to oversee her 110 acres of land within the confines of Rome.
Visiting Vatican City is an once-in-a-lifetime opportunity to experience the history of the Catholic Church and the many historical artefacts possessed by the many museums and basilicas.
Famous for having been destroyed by Mount Vesuvius, over recent decades numerous archaeologists have worked hard to reveal this long-hidden city. Thousands of tons of mud and ash have been removed, allowing one to walk around this eerie landscape where once a thriving community existed.
Once a marshy swampland, Venice grew to become one of the most important trading posts in all of Europe. The wealth that flowed into the city in its heyday can still be felt today, in the form of the many stunning buildings to be enjoyed here.
Of course, no visit to Venice would be complete without a gondola ride, and many of the most beautiful buildings are best viewed from the water.